DOES NEIGHBORHOOD GENTRIFICATION AFFECT FOOD INSECURITY AMONG URBAN OLDER ADULTS? EVIDENCE FROM NEW YORK CITY

Abstract Emerging studies have established that food insecurity is a prevalent public health problem among older adults, including those in urban areas. However, the relationship between neighborhood gentrification, an increasing trend in urban development, and food insecurity remains unclear. Using cross-sectional data from the Poverty Tracker Study, this study aimed to answer two research questions: 1) what is the association between living in gentrifying neighborhoods and food insecurity? 2) Do the food environment, public transportation, and social cohesion mediate the association? The sample consisted of 710 New York City residents aged 65 or older. Based on respondents’ census tracts, individual-level data were merged with neighborhood data obtained from the American Community Survey. local statistics were estimated by GeoDa 1.20 to examine the spatial distribution and significant clusters of generifying neighborhoods across New York City. ArcGIS 10.1 was then used to produce maps. To address both research questions, logistic regressions and mediation analyses were conducted. Regressions revealed that living in generifying neighborhoods was significantly associated with a greater risk of food insecurity, even after adjusting for demographic characteristics and socioeconomic status, such as income. Additionally, mediation analyses suggested that the association was significantly mediated by community social cohesion and the number of healthy food outlets. Findings suggest that neighborhood gentrification presents a salient risk factor for late-life food insecurity in urban areas. Community programs that foster social connections among neighbors and local food assistance programs may be particularly needed in gentrifying neighborhoods to mitigate and reduce the risk of late-life food insecurity.

end-of-life (EOL) care, the rural vs. urban disparity may indicate poorer EOL quality for rural PWD.Moreover, research on factors affecting ACP use among PWD has been primarily based in metropolitan/urban areas.To address the knowledge gap, this study aimed to explore barriers and current resources for ACP of PWD from perspectives of health and social service providers in rural Alabama.Using a qualitative approach, semi-structured face-to-face interviews were conducted with 10 health and social service professionals serving older adults and their caregivers in rural communities of Alabama.Thematic analysis was used to find recurrent themes and patterns from transcribed interview data.Our analysis revealed four areas of barriers to rural PWD's ACP: (1) PWD's and caregivers' lack of knowledge about ACP, dementia, EOL care options, and available resources, (2) misconceptions of completing formal documentations, (3) emotional barriers, and (4) limited access to existing resources.Elder law clinic and local Area Agencies on Aging were the most prominent, existing resources for ACP in rural Alabama.Participants also showed a type of misconception that a lawyer and/or a notary is required for ACP.The study highlighted an urgent need for social policy in ACP education for both caregivers and service providers in rural settings.Advance care planning (ACP) is a process that supports adults at any stage of health in ensuring that their values, goals, and wishes are met regarding future medical care.Factors associated with completing ACP include older age, being White, higher education, and higher socioeconomic status.However, scant research has investigated if these same characteristics are associated with ACP among lesbian and gay adults.Using data from an online survey (N=139), bivariate analyses were conducted to investigate predictors of ACP outcome measures.Being White (p<.01),older (p<.01), and employed (p<.05) were associated with having a higher level of comfort with medical decision making.Having a higher income (p<.01),being employed (p<.01), and having a health condition (p<.05) were associated with having completed a living will.Having a higher income (p<.01)and being employed (p<.05) were associated with having a durable power of attorney for healthcare.These outcomes demonstrate that while some variables were similar to previous findings, additional sociodemographic characteristics were found to have an influence on ACP among older lesbian and gay adults.Given that completing ACP has shown to improve quality of care at end of life, it is imperative to understand what factors influence ACP for older lesbian and gay adults.Understanding these within group differences will lead to future research and outreach efforts developed to inform and equip healthcare workers and community organizations with the means to better serve older gay and lesbian adults, a group that has been historically discriminated against by the healthcare system.

UNDERUTILIZATION OF HOSPICE CARE IN OLDER BLACK ADULTS Channing Tate, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
Hospice is underutilized in Black Americans despite evidence that Black Americans benefit from hospice services.There are several potential reasons hospice is underutilized in Black Americans including lack of knowledge of hospice, poor opinions of hospice, and low self-efficacy in end-of-life decision-making.Patient decision aids are one technique used to improve patient knowledge and agency in making medical decisions.This research project endeavored to addresses potential barriers to hospice enrollment in Black adults and evaluates if a hospice specific patient decision aid could improve hospice knowledge, opinions of hospice, and decision-making self-efficacy.The study was a pilot randomized controlled trial that enrolled Black adults aged ≥ 65 years.The three primary outcomes for the study included hospice knowledge measured by the Hospice Knowledge Scale, opinions of hospice measured by the Hospice Beliefs and Attitudes Scale, and confidence in making decisions measured by the Decision Self-Efficacy Scale.Additionally acceptability and usability outcomes of the decision aid were collected.All participants completed the three baseline surveys prior to randomization.Those randomized to the intervention were provided with the hospice patient decision aid while those in the control did not receive the decision aid.Hospice knowledge, opinions of hospice, and decision self-efficacy improved from baseline to one-month follow-up in the intervention group, but between group (intervention vs control) differences were not statistically significant.Overall acceptability outcomes were favorable, and participants stated the patient decision aid would be beneficial in facilitating hospice decision making.

DOES NEIGHBORHOOD GENTRIFICATION AFFECT FOOD INSECURITY AMONG URBAN OLDER ADULTS? EVIDENCE FROM NEW YORK CITY
Ethan Siu Leung Cheung, University of Utah, Salt Lake City, Utah, United States Emerging studies have established that food insecurity is a prevalent public health problem among older adults, including those in urban areas.However, the relationship between neighborhood gentrification, an increasing trend in urban development, and food insecurity remains unclear.Using cross-sectional data from the Poverty Tracker Study, this study aimed to answer two research questions: 1) what is the association between living in gentrifying neighborhoods and food insecurity?2) Do the food environment, public transportation, and social cohesion mediate the association?The sample consisted of 710 New York City residents aged 65 or older.Based on respondents' census tracts, individual-level data were merged with neighborhood data obtained from the American Community Survey.local statistics were estimated by GeoDa 1.20 to examine the spatial distribution and significant clusters of generifying neighborhoods across New York City.ArcGIS 10.1 was then used to produce maps.To address both research questions, logistic regressions and mediation analyses were conducted.Regressions revealed that living in generifying neighborhoods was significantly associated with a greater risk of food insecurity, even after adjusting for demographic characteristics and socioeconomic status, such as income.Additionally, mediation analyses suggested that the association was significantly mediated by community social cohesion and the number of healthy food outlets.Findings suggest that neighborhood gentrification presents a salient risk factor for latelife food insecurity in urban areas.Community programs that foster social connections among neighbors and local food assistance programs may be particularly needed in gentrifying neighborhoods to mitigate and reduce the risk of late-life food insecurity.

HEALTH STATUS AND ENVIRONMENTAL FACTORS ASSOCIATED WITH OLDER ADULTS' MOBILITY IN 2021 COMPARED TO 2020 Namkee Choi, University of Texas, Austin, Texas, United States
The COVID-19 pandemic has had significant negative impact on life-space mobility of people of all ages around the world.Using the 2019-2021 National Health and Aging Trend Study (N=3,063, age 70+) and the socioecological mobility framework, we examined the changes in the frequency of going outside among U.S. older adults between 2020 (during the pandemic) and 2021 (post-COVID vaccine).Respondents self-reported changes in their frequency of going outside: no change (=about the same), increased frequency (=more often), and decreased frequency (=less often).We then fit multinomial logistic regression to examine the associations of the changes in the frequency of going outside with physical, psychosocial, and cognitive health, environmental (COVID concerns and transportation) factors, and social media use, controlling for the 2020 frequency of going outside.We found that in 2021 compared to 2020, 13% and 16% of those age 70+ reported increased and decreased frequencies, respectively.Increased frequency was associated with social media use.Decreased frequency was associated with poor physical health, depression/anxiety, and perceived memory decline.COVID concerns and transportation problems, as well as female gender, age 90+, and being non-Hispanic Black, were also significant correlates of decreased frequency.In conclusion, most U.S. adults age 70+ appear to have resumed their 2019 level of frequency of going outside in 2021 after the COVID vaccines became available; however, 16% reported decreased frequency of going outside in 2021 compared to 2020.Older adults with physical, mental, and cognitive health challenges need help to increase their frequency of going outside.

NEIGHBORHOOD CHARACTERISTICS AND SLEEP PROBLEMS: MEDIATING ROLES OF HEALTH BEHAVIORS AND MENTAL HEALTH
Ethan Siu Leung Cheung, University of Utah, Salt Lake City, Utah, United States Existing studies have well-documented the relationship between the neighborhood environment and health among older adults.Yet very few have focused on how the neighborhood environment predicts late-life sleep quality.Using longitudinal data (Rounds 7-9) from the National Health and Aging Trends Study, this study examined the cross-sectional and longitudinal associations between neighborhood characteristics (physical disorder and social cohesion) and sleep problems among Americans aged 65 or older, as well as whether health behaviors and mental health mediated these associations.The analytical sample included 4,029 adults aged 65 or older.Logistic regressions with a lagged dependent variable were adopted to test longitudinal associations.Longitudinal mediation analyses were also used to examine the mediation effects of health behaviors and mental health.The results suggested that neighborhood physical disorder was a significant predictor of sleep problems cross-sectionally, whereas social cohesion was both cross-sectionally and longitudinally associated with sleep problems.Moreover, mediation analysis revealed that health behaviors and mental health significantly mediated the longitudinal relationship between social cohesion and sleep problems, though the strength of the indirect effect diminished over time.These findings suggest that neighborhood physical disorder and social cohesion are significant predictors of late-life sleep problems among older Americans.The study also highlighted older adults' resilience and adaptability to adverse neighborhood environments and the long-term health benefits of social cohesion in late-life sleep quality.Therefore, community health interventions that facilitate older adults' physical and social activity, along with mental health programs, may help community-dwelling older adults improve their sleep quality.

THE DIRECT EFFECT OF COMMUNITY-LEVEL RISK FACTORS ON LUNG CANCER INCIDENCE IN FOUR NEW ENGLAND STATES
Taylor Jansen 1 , Qian Song 1 , Kristie Long-Foley 2 , and Elizabeth Dugan 3 , 1. University of Massachusetts Boston, Boston, Massachusetts, United States, 2. Wake Forest University School of Medicine, North Carolina,United States,3. University of Massachusetts,Boston,Boston,Massachusetts,United States Lung cancer is the most common cancer globally and 70% of diagnoses are among the 65+ population.This study identifies what town-level risk factors are contributing to geographic disparities in 65+ lung cancer in N=796 towns in Connecticut, Massachusetts, New Hampshire, and Rhode Island.Multiple spatial-based analyses (e.g., Moran's I, Getis-Ord Gi*, mapping) were conducted before running a series of spatial regression models to determine the association between town-level risk factors (i.e., environmental exposures,